Medical Cannabis – where are we now (part 2)?

We wrote on this topic in 2022. The remainder of this blog reviews what has changed, and how we see the future medical cannabis space developing.

Almost six years following a change in the law and despite growth in the sector, many individuals are still struggling to access a consistent supply of cannabis-based medicines and there are concerns that patients’ lives are at risk.

In November 2018, the laws in the UK were updated to permit prescriptions of unlicensed cannabis-based medicinal products in certain circumstances. Cannabis otherwise remains a controlled drug under the Misuse of Drugs Act 1971. One of the instrumental reasons for the change was the campaigns led on behalf of Alfie Dingley, a child who suffered up to 150 epileptic fits a week. Alfie was granted a licence to use cannabis oil and has been seizure free for three and a half years, but is one of very few children to receive an NHS prescription since legalisation.

nhs prescriptions

Very few people in England are likely to get an NHS prescription for medical cannabis and it is only considered when other treatments are not suitable or have not helped (i.e. medication resistant epilepsy). Currently, it is only likely to be prescribed for the following conditions (as based on criteria set by the National Institute of Clinical Excellence (NICE):

• children and adults with rare, severe forms of epilepsy
• adults with vomiting or nausea caused by chemotherapy
• people with muscle stiffness and spasms caused by multiple sclerosis (MS).

Private prescriptions

On the other hand, in the private medical sphere, specialist doctors registered with the General Medical Council (GMC) can legally prescribe cannabis-based products for medicinal use and are able to prescribe for a much broader range of conditions, provided certain criteria are met. This includes a qualifying medical condition, unsuccessful trials of conventional medications and the doctor’s belief in the benefit for the patient. Although GPs are not currently authorised to prescribe, they can refer patients to specialists.

growth of the market

Figures released by the Home Office in October 2023 demonstrate that the amount of medical cannabis imported has more than tripled in volume compared to 2022. It is estimated that there are currently around 30,000 to 32,000 patients in the UK, which is a relatively small market in comparison to comparable countries where medical cannabis has also been legalised.

Surveys have shown that British people remain largely unaware of the legal changes surrounding medical cannabis, including police officers. It is therefore possible that the more people are educated about this and consumer demand increases, there will be a knock-on effect on the supply available.

In addition, experts predict that the market displays a consistent and positive growth direction over the next 8 years and specialist practices are gearing up to cater for the ever-growing demand. They consider this growth is propelled by factors including increasing consumer demand, advancements in technology, and shifting consumer preferences. Further market growth is also enhanced by the emergence of more efficient and sustainable technological advancements within the industry. In addition, medical cannabis cultivation companies are beginning to appear online in the UK, potentially reducing the need for imports, which have their own issues.

supply issues and risks

Despite the growth of the market, research shows that an overwhelming number of individuals who need a medical cannabis prescription in the UK still cannot access one, or are not without problems in doing so. Factors such as inflation, supply chain disruptions, EU legislation changes and global economic uncertainties have contributed to a volatile market. Most recently, crop failures and cancellations of transit have contributed to a delay in supply, however it is argued that supply chains should now be resilient to such events and it should not remain an ongoing concern. More generally, there remains disparity in the accessibility between the NHS and private market. 

In relation to the NHS, it seems that a very cautious and evidence-based approach is being taken, and although the guidelines set by NICE are not mandatory, most NHS trusts will not support prescribing outside of them. A Department of Health government spokesperson said "the most significant barrier to access licensed cannabis-based products funded by the NHS is the lack of evidence on the quality, safety, and clinical and cost-effectiveness. In the absence of this evidence, clinicians will remain reticent to prescribe and decisions cannot be made on NHS funding. That is why the government is focused on generating research."

In the private sector, it seems that finance is a significant barrier to treatment for many individuals and although the cost varies, the average monthly cost per patient is around £1,800.

For those patients that do have access to medication, many concerned parents have reported being informed that prescriptions for their children cannot be filled or will be delayed and they have received advice to change products. For some individuals, including children, the reliance on medical cannabis to treat their conditions is life changing and without it there is a very serious risk to their wellbeing. Dr Evan Cole Lewis, director of the Neurology Centre of Toronto (NCT) has commented that changing medication “can be highly unsafe and could result in worsening seizures, or breakthrough seizures.” It is therefore imperative that patients have access to a consistent supply of their regular medication. Professor Mike Barnes, who is one of the doctors currently prescribing medication for paediatric epilepsy in the UK considers there is a major supply chain issue and that there would be better supply if the NHS would increase prescriptions.

One of the other major risks that follows from the supply issues is the dangers resulting from individuals self-medicating and using cannabis illegally to try and treat their health conditions. There is of course no guarantee on the quality of cannabis and there are risks that it could in fact exacerbate symptoms. Following a YouGov poll, commissioned by medical cannabis clinic Sapphire Medical Clinics in 2023, it was claimed 1.8 million people in the UK use the illegal cannabis market to alleviate symptoms, which is an increase of 29% from 2019.

It is hoped that the UK medical cannabis sector can work together to understand the potential weaknesses and delays in supply to put in place appropriate measures to maintain a consistent and safe supply.

FURTHER INFORMATION

If you have any questions regarding this blog, please contact Shannett Thompson or Zenia Birring in our Regulatory team.

ABOUT THE AUTHORS

Shan is a Partner in the Regulatory Team and is the firm’s Training Principal. She trained in the NHS and commenced her career exclusively defending doctors. She provides regulatory advice predominantly in the health and social care and education sectors.

Zenia is a trainee solicitor at Kingsley Napley and is currently in her second seat with the Regulatory team, having completed her first seat with the Divorce and Family team.